The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo.
epidemiology
healthcare workers
humanitarian crisis
insecurity
Journal
Proceedings of the National Academy of Sciences of the United States of America
ISSN: 1091-6490
Titre abrégé: Proc Natl Acad Sci U S A
Pays: United States
ID NLM: 7505876
Informations de publication
Date de publication:
26 11 2019
26 11 2019
Historique:
pubmed:
23
10
2019
medline:
28
4
2020
entrez:
23
10
2019
Statut:
ppublish
Résumé
The interplay between civil unrest and disease transmission is not well understood. Violence targeting healthcare workers and Ebola treatment centers in the Democratic Republic of the Congo (DRC) has been thwarting the case isolation, treatment, and vaccination efforts. The extent to which conflict impedes public health response and contributes to incidence has not previously been evaluated. We construct a timeline of conflict events throughout the course of the epidemic and provide an ethnographic appraisal of the local conditions that preceded and followed conflict events. Informed by temporal incidence and conflict data as well as the ethnographic evidence, we developed a model of Ebola transmission and control to assess the impact of conflict on the epidemic in the eastern DRC from April 30, 2018, to June 23, 2019. We found that both the rapidity of case isolation and the population-level effectiveness of vaccination varied notably as a result of preceding unrest and subsequent impact of conflict events. Furthermore, conflict events were found to reverse an otherwise declining phase of the epidemic trajectory. Our model framework can be extended to other infectious diseases in the same and other regions of the world experiencing conflict and violence.
Identifiants
pubmed: 31636188
pii: 1913980116
doi: 10.1073/pnas.1913980116
pmc: PMC6883813
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
24366-24372Subventions
Organisme : NIGMS NIH HHS
ID : U01 GM087719
Pays : United States
Commentaires et corrections
Type : CommentIn
Déclaration de conflit d'intérêts
The authors declare no competing interest.
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